What is rejection sensitive dysphoria (RSD)?

Studies show that as many as 45% of children with ADHD also have difficulty with emotional dysregulation. One aspect of emotional dysregulation is called rejection sensitive dysphoria (RSD), something psychiatrist Dr. William Dodson describes as “a triggered, wordless emotional pain that occurs after a real or perceived loss of approval, love, or respect.”

It’s important to understand that rejection sensitive dysphoria is not a diagnosis. The term describes an extreme emotional sensitivity and pain that’s triggered by a sense of rejection or criticism by important people, such as parents/siblings, teachers, or peers. Dr. Dodson writes that approximately one-third of adolescents and adults list RSD as the most impairing aspect of their ADHD.

There is very little research or data on RSD and no official symptoms. However, that doesn’t mean that children with ADHD can’t also struggle with negative messaging and rejection.

“A lot of children with ADHD have had far more negative terms being used,” Dr. Amin says. “So if you’re constantly in an environment where you grow up hearing those messages, it is easier to get upset when someone gives negative feedback.” And then there’s the neurological factor: Dr. Amin explains that the ADHD brain is “unable to tone down the signals from the amygdala,” a part of the brain that is associated with regulating emotion. She also mentions that co-occurring conditions, such as a sleep disorder, may impact emotional regulation. If you’re constantly sleep-deprived, it’s much harder to regulate emotions.

Addressing emotional dysregulation is similar to addressing symptoms of ADHD. Therapy can help a child learn to develop coping skills related to how to process, manage, and contain feelings so that they’re less overwhelming. Children with ADHD may have a tendency to latch onto negative messages, Dr. Haranin says, so using praise and reinforcement rewards to motivate positive behavior is key.

Learn more in our article ADHD 101.